OP0078 PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES ARE NOT AT INCREASED RISK OF LONG-COVID: DATA FROM A LARGE PROSPECTIVE CONTROLLED COHORT STUDY
Authors: L. Boekel, S. Atiqi, M. Leeuw, F. Hooijberg, Y. Besten, W. Lems, A. Boonen, S. Tas, M. Nurmohamed, T. Rispens, G. Wolbink
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Studies on long-term consequences of COVID-19, commonly referred to as long-COVID, in patients with inflammatory rheumatic diseases (iRD) are still scarce, and available data are heterogeneous and largely inconclusive. In addition, it is unknown whether correctly classifying patients with iRD as long-COVID cases is complicated by increased background noise due to the occurrence of persistent symptoms that could be attributed to both long-COVID and iRD. <h3>Objectives</h3> The primary objective was to compare the risk of developing long-COVID after a SARS-CoV-2 infection with the Omicron variant between patients with iRD and age and sex matched healthy controls. A secondary objective was to compare the prevalence of the different persistent symptoms observed in long-COVID between patients with iRD and healthy controls with and without a history of COVID-19. <h3>Methods</h3> We collected data from participants enrolled in a Dutch prospective cohort study that was designed to compare the disease severity of COVID-19 between iRD patients and healthy controls from the start of the pandemic. Demographic and clinical data, including data on the occurrence of SARS-CoV-2 infections, were collected via online questionnaires. On March 10, 2022, all study participants were asked about the occurrence, onset, severity and duration of persistent symptoms during the first two years of the COVID-19 pandemic, independent of their history with COVID-19. Subsequently, we prospectively monitored a subset of the cohort, participants with a PCR or antigen confirmed SARS-CoV-2 Omicron infection, for COVID-19 sequelae. In line with WHO guidelines, long-COVID cases were defined as participants who reported persistent symptoms that lasted at least 8 weeks, started after the onset and within 3 months of a confirmed SARS-CoV-2 infection, and could not be explained by an alternative diagnosis. Descriptive statistics, logistic regression analyses and Kaplan Meier survival analyses were used for statistical analyses. <h3>Results</h3> A total of 1974 iRD patients and 733 healthy controls participated, of whom 468 (24%) patients and 218 (30%) controls had a SARS-CoV-2 Omicron infection. Of those, 361 (77%) patients and 172 (79%) controls completed COVID-19 sequelae questionnaires. More patients compared to controls fulfilled long-COVID criteria; 77 (21%) vs. 23 (13%) respectively (OR: 1.73, 95% CI: 1.04 – 2.87, <i>P</i> 0.03; Table 1). However, the effect attenuated after adjusting for potential confounders (aOR: 1.49, 95% CI: 0.88 – 2.52, <i>P</i> 0.14; Table 1). Post-hoc evaluation of covariables in the regression model showed that higher BMI and worse disease severity of the acute infection phase of SARS-CoV-2 were significantly associated with higher odds of developing long-COVID (Table 1). Fatigue and loss of fitness were the most frequently reported symptoms in both iRD patients and healthy controls with long-COVID, and recovery time from long-COVID was similar for patients and controls (<i>P</i> 0.47). Lastly, persistent symptoms were reported more frequently by participants with a history of COVID-19 compared to those without a history of COVID-19; 43% of iRD patients vs. 33% of controls with a history of COVID-19, and 21% of iRD patients vs. 11% of controls without a history of COVID-19. <h3>Conclusion</h3> We found that 21% of iRD patients and 13% of healthy controls met WHO-criteria for long-COVID after a SARS-CoV-2 Omicron infection. However, confounding by BMI and severity of the acute infection phase of SARS-CoV-2 attenuated this difference, and the duration of long-COVID was similar between patients and controls. In addition, since more iRD patients than healthy controls without a history of COVID-19 reported symptoms that are also observed in long-COVID, we believe that the observed difference in long-COVID between patients and controls could in part also be explained by clinical manifestations of underlying rheumatic diseases. We therefore conclude that iRD patients are not more susceptible for long-COVID than people from the general population. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.